What is this condition?

The dominant effect of this disease is the loss of oxygen and nutrients to the heart because of diminished blood flow through the heart’s arteries. This disease is near epidemic in the Western world.

Coronary artery disease occurs more often in men than in women, in whites, and in middle-aged and elderly people. In the past, it rarely affected premenopausal women, bur that’s no longer the case - perhaps because many women now take oral contraceptives, smoke cigarettes, and are employed in stressful jobs that used to be held exclusively by men.

What causes it?

Axherosclerosis is the usual cause of coronary artery disease. In atherosclerosis, fatty and fibrous plaques narrow the interior channel of the heart’s arteries. They reduce the volume of blood that can flow through the arteries, thereby damaging the heart. Plaque formation also predisposes a person to thrombosis (blood clot formation), which can provoke a heart attack.

Atherosclerosis usually develops in high-flow, high-pressure arteries, such as those in the heart, brain, and kidneys, and in the aorta. It has been linked to many risk factors: family history, high blood pressure, obesity, smoking, diabetes, stress, sedentary lifestyle, and high cholesterol and triglyceride levels.

Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow.

What are its symptoms?

The classic symptom of coronary artery disease is angina, which results from inadequate flow of oxygen to the heart. Angina is described as a burning, squeezing, or tight feeling in the chest that may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the person clenches his or her fist over the chest or rubs the left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool arms and legs.

Anginal episodes most often follow physical exertion bur may also follow emotional excitement, exposure to cold, or a large meal. Severe and prolonged anginal pain generally suggests a heart attack.

How is it diagnosed?

The person’s history - including the frequency and duration of angina and the presence of associated risk factors - is crucial in evaluating coronary artery disease. Diagnostic test results include the following:

• Electrocardiogram during angina shows heart damage and, possibly, an irregular heart rhythm. It tends to be normal when the person is pain-free.
• Treadmill or bicycle stress test may provoke chest pain and signs of heart damage.
• Coronary angiography reveals coronary artery narrowing or block­age.
• Myocardial perfUsion imaging (with thallium-20l or Cardiolite) during treadmill exercise detects damaged areas of the heart, seen as “cold spots.”

How is it treated?

The goal of treatment is to either reduce the heart’s oxygen demand or increase its oxygen supply. Drug therapy consists primarily of nitrates such as nitroglycerin (given beneath the tongue, orally, through the skin in patch form, or topically in ointment form), Isordil (given beneath the tongue or orally), beta blockers (given orally), or calcium channel blockers (given orally).

Blocked coronary arteries may necessitate coronary artery bypass surgery and the use of vein grafts. In people with only partial block­age of the coronary arteries, the doctor may perform angioplasty, a procedure in which a catheter is used to compress fatty deposits and relieve blockages. Laser angioplasty, a newer procedure, corrects the blockage by melting fatty deposits.

Because coronary artery disease is so widespread, prevention is very important. Dietary restrictions aimed at reducing intake of calories (in obesity) and of salt, fats, and cholesterol serve to minimize the risk, especially when supplemented with regular exercise. Stopping smoking and reducing stress are also beneficial.

Other preventive actions include controlling high blood pressure, reducing triglyceride levels, and taking 2.5 grains of aspirin daily (to reduce the threat of blood clots).

What can a person with coronary artery disease do?

• Be sure to follow the prescribed drug therapy, exercise program, and diet.
• Get regular, moderate exercise.
• Enroll in a self-help program to stop smoking .

What is this condition?

A major cause of blindness worldwide, corneal ulcers produce scar­ring or perforation of the cornea. They occur in the central or marginal areas of the cornea, but marginal ulcers are the most common form. A person may have one or several ulcers, of varied size and shape. Prompt treatment (within hours of onset) can prevent visual impairment.

What causes it?

A corneal ulcer generally results from infections by protozoa, bacteria, viruses, or fungi. Other causes include trauma, exposure, vitamin A deficiency, toxins, and allergens.

What are its symptoms?

Typically, a corneal ulcer causes pain (aggravated by blinking) and sensitivity to light, followed by increased tearing. Eventually, a central corneal ulcer blurs vision markedly. Bacterial ulcers may produce a pus-filled discharge.

How is it diagnosed?

A history of trauma or use of contact lenses and a penlight exam that reveals an irregular corneal surface suggest a corneal ulcer. Fluoresce-in dye, instilled in the conjunctival sac, stains the outline of the ulcer and confirms the diagnosis. Cultures of corneal scraping may identify the causative bacterium or fungus.

How is it treated?

Treatment aims to relieve pain and eliminate the underlying cause of the ulcer, as follows:

• Pseudomonas aeruginosa: the antibiotics Aerosporin and Garamycin, given topically and by subconjunctival injection, or Geocillin and Tobrex given intravenously. Since this type of corneal ulcer spreads so rapidly, it can cause corneal perforation and loss of vision within 48 hours. Immediate treatment and isolation of hospitalized patients are required. Eye coverings are never used when treating bacterial corneal ulcers .
• herpes simplex type 1 virus: hourly topical application of Herplex or Vira-A Ophthalmic. Corneal ulcers resulting from a viral infection often recur .
• varicella-zoster virus: a topical sulfonamide ointment applied 3 to 4 times daily to prevent secondary infection. These lesions are typically painful, so the person also receives pain relievers .
• fungi: instillation of Natacyn eyedrops for Fusarium, Cephalosporoium, and Candida
• vitamin A deficiency: correction of dietary deficiency or malabsorption of vitamin A
• neurotropic ulcers or exposure keratitis: frequent instillation of artificial tears or lubricating ointments and use of a plastic bubble eye shield.

Prompt treatment is essential for all forms of corneal ulcer to prevent complications and permanent vision problems or blindness.